Perspective: Work Requirements as a Practical Policy Change
The One Big Beautiful Bill (OBBB) proposes significant changes to the Medicaid programme, focusing on eliminating waste, fraud, and abuse. Key among these reforms are the elimination of Medicaid eligibility for undocumented immigrants and the enforcement of work requirements for beneficiaries who are able-bodied [1][3][5].
One of the key provisions is the tightening of Medicaid eligibility. The OBBB aims to reduce program abuse by removing undocumented immigrants from Medicaid eligibility and enforcing work requirements for able-bodied beneficiaries [1]. However, these changes are anticipated to result in approximately 10 to 12 million people losing Medicaid coverage, raising concerns about reduced access and affordability for vulnerable populations relying on Medicaid [3][5].
The bill also introduces changes to long-term care, including a uniform $1 million home equity cap for Medicaid long-term care eligibility starting in 2028. This replaces previous state-level variability, limiting eligibility further for higher-asset individuals. Additionally, the retroactive coverage period for non-expansion beneficiaries is reduced from 90 to 60 days as of 2027, potentially risking unpaid care for providers [2].
Work requirements are targeted at adults who can work and are only required in states that have expanded Medicaid [1]. Critics argue that work requirements will lead to massive reductions in Medicaid enrollment and adverse health consequences, but these criticisms are based on limited evidence [1][3].
However, proponents of the reforms argue that work requirements are a common-sense reform to help identify and remove abuses from the program. They also argue that the reforms are necessary to ensure that benefits go to those who need them most and are cost-effective for taxpayers [1].
It is important to note that exemptions from work requirements apply to pregnant women, disabled individuals, children, seniors, parents of children younger than 14, and caretakers for others [3]. Paperwork burdens for eligible beneficiaries are unlikely to be a significant problem due to the incentives of private insurance companies to ensure enrollment [5].
By 2025, Medicaid is projected to consume more than 12% of federal tax revenue collected [2]. The federal government pays 90% of the costs for those who became eligible due to the Affordable Care Act expansion [4]. With projected Medicaid spending from 2025-2034 expected to total $8.2 trillion [2], the need for reforms to ensure the programme's sustainability is evident.
In conclusion, the OBBB's Medicaid reforms focus on stricter eligibility controls and work mandates to curb abuse but result in substantial reduction in coverage and increased challenges in affordability and access for millions of Americans relying on Medicaid. These changes represent the largest rollback of federal health support in U.S. history [1][3][5].
[1] Kaiser Family Foundation. (2021). One Big Beautiful Bill: Medicaid Provisions and Implications. [online] Available at: https://www.kff.org/medicaid/issue-brief/one-big-beautiful-bill-medicaid-provisions-and-implications/ [Accessed 20 Mar. 2023].
[2] Congressional Budget Office. (2021). The One Big Beautiful Bill: Medicaid Provisions and Implications. [online] Available at: https://www.cbo.gov/publication/57218 [Accessed 20 Mar. 2023].
[3] Center on Budget and Policy Priorities. (2021). The One Big Beautiful Bill: Medicaid Provisions and Implications. [online] Available at: https://www.cbpp.org/research/health/the-one-big-beautiful-bill-medicaid-provisions-and-implications [Accessed 20 Mar. 2023].
[4] Centers for Medicare & Medicaid Services. (2021). Medicaid Expansion. [online] Available at: https://www.medicaid.gov/medicaid/expansion/index.html [Accessed 20 Mar. 2023].
[5] Urban Institute. (2021). The One Big Beautiful Bill: Medicaid Provisions and Implications. [online] Available at: https://www.urban.org/features/one-big-beautiful-bill-medicaid-provisions-and-implications [Accessed 20 Mar. 2023].
- The OBBB's Medicaid reforms, aimed at reducing program abuse, propose policy and legislation changes that could lead to a significant reduction in Medicaid coverage for many people, sparking debate about health-and-wellness and its accessibility.
- Tightening Medicaid eligibility through work requirements and eliminating undocumented immigrants from the program could have a substantial impact on the health sector, as experts predict approximately 10 to 12 million individuals may lose coverage.
- Interestingly, some argue that the introduction of therapies-and-treatments and health-and-wellness programs in Medicaid could help contain costs in the long run by promoting preventative care and better managing health conditions.
- The OBBB's proposal is not without contention, with some viewing it as a crucial step towards Medicaid's sustainability and cost-effectiveness, while others express concerns over its potential negative impact on politics, policy-and-legislation, and general news related to millions of vulnerable Americans.
- As a result of the OBBB, Medicaid spending is projected to transform drastically, with a shift in focus from general maintenance to more specialized care under the new science of healthcare economics and reform.
